The increased use of cancer (CA) chemotherapy (CTX) has been accompanied by a growing number of reports on CTX anaphylaxis (AP). Currently there are no guidelines for its diagnosis, treatment or prevention.

Charts of Rush University Medical Center (RUMC) outpatients identified with CTX AP during 2002-3 were reviewed. Data concerning the clinical presentation and possible risk factors were recorded for each case. The literature on CTX AP was reviewed using the PubMed and Ovid search engines. This study was RUMC IRB-approved and HIPAA-compliant.

8 cases of CTX AP, all involving females, ages 35-70 yr (mean, 52 yr) were identified. Three had ovarian CA; 3, breast CA and 1, lung CA; the 8th was an oncology nurse without CA. Presenting signs were cutaneous (4 cases), respiratory (3) or cardiovascular (2); gastrointestinal reactions were not observed. CTX AP was associated with doxorubicin, carboplatin or cyclophosphamide (3 cases each) and adriamycin, etoposide or paclitaxel (1 case each) during second or subsequent exposure to the agent, despite prophylaxis in 5 cases with an antihistamine or dexamethasone alone or in combination. One case required intensive care, but none was fatal. Potential risk factors included a prior drug reaction (4) or previous AP (1); no subject was atopic by history or had been skin tested for CTX or other hypersensitivity. Our findings were in general agreement with previous reports of CTX AP.

AP to CTX in this case series was not associated with atopy or prevented by conventional prophylaxis and may not be IgE-mediated.